ISSN:0963-0643    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Guidelines within the healthcare system aim to rationalize the diagnosis, treatment and follow-up of a particular disease and can be applicable on an international scale or may be country specific. Specialists, who determine the clinical evidence for individual practices, prepare these guidelines, and the strength of these recommendations depends on available evidence. The assessment of patients includes a minimal number of non-invasive tests. Only in cases of abnormalities are additional (more invasive) tests recommended. Treatment decisions should be evidence-based but, despite guidelines, the choice of treatment is often highly dependent on the personal preference of the urologist. Patients' awareness of different treatment options and their involvement in choosing a treatment is also increasing. Economical aspects are becoming more and more important in making healthcare decisions. Data on durability of treatments, however, are limited and deserve special attention in order to provide the most cost-effective care for different patient groups.

ISSN:0963-0643    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Over the last decade, a number of minimally invasive therapies have been investigated for the treatment of symptomatic benign prostatic hyperplasia. Most of these therapies use thermal energy to ablate prostatic tissue. The major common problem with all these new minimally invasive therapies has been the lack of long-term data concerning efficacy, re-intervention rates and side-effects. We present here the available long-term data on these alternative minimally invasive therapies for benign prostatic hyperplasia and their current place in the urologist's armamentarium.

ISSN:0963-0643    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

There are numerous plant extracts that have been used for the treatment of benign prostatic hyperplasia and lower urinary tract symptoms. While some extracts show promise, their efficacy has not been adequately proven in long-term, double-blind placebo-controlled trials monitored by an outside agency.

ISSN:0963-0643    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

A literature search was performed for articles between June 2000 and July 2001 pertaining to transurethral resection of the prostate. Eight of the most interesting and/or groundbreaking articles, as deemed by the authors, were selected for review. Topics discussed include transurethral vaporization of the prostate, laser prostatectomy, preoperative finasteride, pelvic floor rehabilitation, the impact of the quantity of tissue removed, bladder infusion prior to catheter removal, and ethanol-glycine in assessment of the absorption of irrigation fluid.

ISSN:0963-0643    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The proliferation of prostatic tissue as a result of ageing typically leads to prostatic enlargement, which often causes obstruction of urine outflow from the bladder, clinically lower urinary tract symptoms, detrusor instability, incomplete bladder emptying, urinary infection, and finally acute urinary retention. The first approach to therapy depending on the severity of the symptoms is usually medical management (phytotherapy, α-blockers, 5α-reductase inhibitors) before surgical procedures are performed. The reference standard for treatment of benign prostatic hyperplasia is transurethral resection of the prostate, although the introduction of minimally invasive alternatives such as transurethral microwave thermotherapy has led to a new era in surgical management. Suitable patients must be selected carefully on the basis of individual parameters that predict a favourable result.

ISSN:0963-0643    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Urinary tract infections are among the most frequent infections encountered in developed countries. The vast majority of community-acquired urinary tract infections are caused byEscherichia coli. However, other bacterial species play an important role in nosocomial urinary tract infections. All these species are equipped with a variety of virulence factors. The best characterized are those fromEscherichia coli. Among the first virulence factors that come into play during establishment of a urinary tract infection are adhesins. Besides their primary function as adhesin molecules several other additional functions can now be attributed to these organelles. Adhesins may also function as invasins, promote biofilm formation and transmit signals to epithelial cells resulting in inflammation. Furthermore, subunit proteins of adhesins seem to be promising vaccines. Later in infection, toxins seem to enhance virulence. However, for cytotoxic necrotizing factor type 1 this is controversial. Many virulence factors of uropathogenic bacteria are encoded by foreign DNA stretches inserted into the core genome. These pathogenicity islands or islets were obviously acquired via horizontal gene transfer creating new pathotypes more efficient in establishing infection. The role of new virulence factors and the new functions of already known virulence factors will be discussed as well as the concept of the composite genome of uropathogenicEscherichia coli.

ISSN:0963-0643    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The aim of imaging in urinary tract infection is to detect conditions that must be treated in order to avoid immediate deterioration or recurrences, and probable long-term kidney damage. In newborns identified with hydronephrosis during pregnancy or by neonatal screening, vesicoureteral reflux and renal scarring are congenital and not caused by infection. Most of these patients are male and the vesicoureteral reflux is of a higher grade than that detected in girls having had urinary tract infection. In children with urinary tract infection, several authors advocate a more selective policy and recommend imaging only in those children who are at risk for developing renal damage. In adult females no imaging is necessary in cystitis, whereas ultrasonography and plain films are recommended in acute pyelonephritis. Because uncomplicated urinary tract infection in men is rare, diagnostic evaluation including imaging should be started early in order to rule out complicating factors within the urinary tract. The role of imaging in prostatitis, vesiculitis, epididymitis and orchitis is primarily to rule out abscess formation, but also to exclude testicular malignancies.

ISSN:0963-0643    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Urinary tract infection is the most frequently reported secondary impairment in individuals with spinal cord lesion. The most prevalent risk indicator is an indwelling catheter. Hydrophilic catheters for clean intermittent catheterization may induce lower rates of bacteriuria and long-term urethral complications. Due to chronic bacterial infection within biofilms, an antibacterial treatment based on a urinary culture of bacteria in the urine and its antimicrobial susceptibility may fail to eradicate catheter-associated urinary tract infection. No commercially available drugs are sufficiently active against the bacteria in a mature biofilm. Biomaterials may be modified to decrease the formation of a biofilm. Silver alloy catheters are effective in preventing urinary tract infection when indwelling urinary catheterization is necessary. The risk of systemic argyria in long-term use needs to be evaluated. Suprapubic cystostomy drainage in patients with neurogenic bladder is preferred to an indwelling urethral catheter. In cases of recurring urinary tract infection in patients with a permanent urinary catheter, it may be beneficial to change the catheter every 1 or 2 weeks. There is some evidence that cranberry products may prevent urinary tract infection. In the future, bacterial interference and vaccination may be a possibility for prevention of urinary tract infection.

ISSN:0963-0643    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The importance of urinary tract infection in elderly populations and some of the unique features in its evaluation and therapy are becoming better recognized. In elderly populations in the community there are concerns about increasing antimicrobial resistance in infecting organisms. In postmenopausal women, the importance of vaginal estrogen deficiency as a factor which promotes urinary tract infection is becoming increasingly recognized, leading to therapeutic strategies other than antimicrobials. For elderly residents of long term care facilities, urinary tract infection is very common, and most frequent in those with the greatest functional impairment. Whilst it is recognized that asymptomatic bacteriuria should not be treated, the diagnosis of urinary tract infection in this population often presents a dilemma. In particular, the urine culture is useful only in excluding urinary tract infection, not in making a diagnosis of symptomatic infection. There has been a tendency to manage all clinical deterioration in long term care facility residents who have positive urine cultures as urinary tract infection, contributing to excess antimicrobial use and heightening the problem of antimicrobial resistance. Recently published guidelines and commentaries attempt to address this problem.

ISSN:0963-0643    

出版商:OVID    

年代:2002

数据来源: OVID